Millions 'Should Not Be In A&E' - Exclusive

By Thomas Moore, Health Correspondent

Up to 6.5 million patients every year should avoid going to A&E and be treated by GPs, paramedics and even chemists instead, the doctor leading the review of NHS emergency services claims today.

Around one third of all people who visit A&E each year could be diverted away from hospital under plans to be unveiled shortly by NHS chiefs.

In an exclusive interview with Sky News, the doctor in charge of re-shaping emergency services in England said family doctors, ambulance staff and pharmacists could treat them instead to relieve the pressure on A&E.

Indicating for the first time how he hopes to radically reform A&E, Professor Keith Willett, the national director for Acute Episodes of Care, said: "We know that 15% to 30% of people who turn up to be treated at A&E could have been treated in general practice.

"They did not know that because the system did not obviously make itself available to them."

He said patients with routine medical problems are going to A&E because they cannot get a quick enough appointment with their GP. Others are frustrated by out-of-hours services.

Prof Willett says a long-term solution is needed

"We can look at the way primary care is available to people," he said.

"By changing the way we deliver services we can start to address the demand. We can do the same thing in terms of the ambulance services and how much, how many patients they treat, at the scene, rather than transfer and that's about them having the right information.

"We would look to the public to understand the issues and when the situation does get difficult, to take the advice that I've suggested about phoning first, to get the right advice, to go to the right place, to think of using your general practitioner or indeed your pharmacist, (who) give a lot of advice for minor ailments."

Professor Willett and the medical director for NHS England, Professor Sir Bruce Keogh, will publish their plan for reforming emergency services later this autumn. It is expected to be implemented two years from now.

The plan will acknowledge that demand for care will continue to rise with an ageing population. But it will set out a series of measures for reducing pressure on A&E departments.

They are expected to include:

:: A&E units will have to ensure a consultant is available seven days a week

:: Other senior doctors, such as elderly care specialists, will be expected to help assess and treat patients arriving at A&E

:: Paramedics will treat more patients at home or by the roadside so they don't need hospital care

:: Patients will be encouraged to 'ring first', using the NHS111 helpline to be directed towards appropriate care.

Health Secretary Jeremy Hunt wants GPs to be more proactive

Health Secretary Jeremy Hunt has also said GPs must take on a bigger role. Next week he will call on GPs to do more to prevent patients with chronic conditions, such as diabetes, from suffering emergency complications.

In an interview for State Of Emergency, Sky News' 24 hours of live coverage from Nottingham's Queen Medical Centre which begins today at 5pm, Mr Hunt said: "The role of GPs in caring for older people needs to be proactive - checking up on people, finding out how they are, heading off problems before they happen - rather than reactive.

"GPs are busy, so to make that happen we have to find ways of getting more capacity in the system and that is a big challenge.

"But we have to address that. In the end, if the NHS is to be sustainable, it has to be about prevention as much as cure."

But GPs say they are already doing what they can.

Professor Mike Pringle, president of the Royal College of General Practitioners, said: "They are overwhelmed by the workload they are expected to deliver.

"We have got to start to build general practice, not blame it, not victimise it.

"We have to invest in it if we are going to solve these problems. And I am sure the Secretary of State recognises that."

England's A&E departments were under severe pressure last winter.

Waiting times reached their worst in nine years between January and March 2013, with more than 300,000 patients waiting more than four hours for treatment.

The Government has given the NHS an extra £500m over two years to find short-term solutions to the likely rise in demand for emergency care in the winter months.

Hospitals could bring GPs into A&E departments to see patients with more minor problems and more locum A&E doctors are likely to be employed to fill vacancies.

Only half the training posts for emergency medicine have been filled in the last two years, and more than a third of hospital trusts have vacancies for A&E consultants.

Professor Willett said a long-term solution is required.

"We do have to address the emergency medicine workforce," he said.

"But that will not produce new consultants for several years. So we have to manage the situation and take away from emergency medicine teams those patients who could be managed by other parts of the system.

"Defaulting to seeing an emergency medicine consultant is not necessary for many of those patients and it is frustrating to wait."

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Winter Wonderland: 'Unbelievable' Hail Storm

A freak hail storm left part of a Cornish town looking like a winter wonderland.

After the hottest summer in the county for seven years, residents in Boslowick, Falmouth could have been left wondering if it was already nearing Christmas with the scenes in their streets.

Hail and flash flooding in Falmouth (Pic: Pirate FM)

Resident Tommy Matthews filmed the snowy-like conditions on Friday morning.

He said they were "the likes of which I don't think I've ever seen before".

Mr Matthews added: "You can see the hail just mounting up everywhere and there are rivers of water just pouring down between it.

"It's absolutely unbelievable".

The hail then thawed and coupled with torrential downpours brought flash flooding to the town on Friday night.

Fire crews were scrambled to help pump water away as roads turned to rivers.

Heavy rain and cooler temperatures have led to a major change from summer heat to autumnal weather across much of the UK.

Sky's weather forecaster Isobel Lang said: "Last week's mini heatwave came to an abrupt halt on Friday with heavy, thundery downpours.

"Durham recorded 63mm in just 24 hours which lead to the Environment Agency issuing two flood warnings on the River Esk.

"Parts of Falmouth in Cornwall were transformed into a winter scene after a thunderstorm left a blanket of hail which proceeded to thaw bringing local flooding.

"Storms of this nature are not unusual at any time of the year, although after the week's sunshine and heat, it was a bit of a shock."

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'Devoted' Mum Killed In Holiday Boat Tragedy

A British mother has been killed in a boating accident during a dream holiday with her family in Brazil.

Gillian Metcalf, of Tenterden, Kent, was travelling with her husband and two daughters when their boat was struck at high speed by another vessel.

The 50-year-old died instantly from head injuries during the collision on the Rio Negro river on September 5.

It is believed the other boat did not stop to help.

It was "an accident that should never have happened", her husband Charlie told the Daily Mail.

Daughter Alice, 18, added "she died happy, painlessly and with her family around her".

Friend and colleague Richard Locke said he was "devastated" by the death and paid tribute to Mrs Metcalf, saying "we have all lost a very special person".

Mrs Metcalf was a partner at the affordable housing law firm Sharratts, which she helped set up in 1999.

In a statement on the firm's website, he said: "As you will imagine this news has hit us all very hard.

"Gill was a marvellous lawyer, a generous friend and most of all a loving wife and devoted mother to her two girls."

Mrs Metcalf counted skiing, golf, cinema and reading among her hobbies.

A Foreign Office spokesman said: "We are aware of the death of a British national in Manaus on September 5.

"We are providing consular assistance to the family at this difficult time."

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Osborne Ready To Press Button On Lloyds Sale

By Mark Kleinman, City Editor

George Osborne, the Chancellor, is considering selling part of the Government's stake in Lloyds Banking Group as soon as next week amid rising expectations in the City of a multi-billion pound share placing.

People close to the situation say that the Treasury, Lloyds and UK Financial Investments (UKFI), which manages the taxpayer's stakes in the UK's bailed-out banks, are discussing the prospect of a share sale that could take place within days.

Reports this week that a disposal of part of the Treasury's holding would almost certainly be delayed by concerns over the crisis in Syria were dismissed by Treasury insiders.

They acknowledged, however, that broader market risks, which also include the US Federal Reserve's forthcoming decision about whether to slow the pace of monetary stimulus, remained an "obvious factor in a decision".

"The reality is that a final decision about the timing of a sale hasn't been made yet but selling next week is a definite option," said one.

Sky News understands that:

:: JP Morgan, the investment bank advising UKFI on its privatisation strategy, has told the Treasury agency that a profitable sale for the taxpayer would be possible within days based on its assessment of the appetite for Lloyds shares among major institutional investors.

:: A number of major City shareholders have this week encouraged the Government to initiate a sale following the agreed takeover of Vodafone's stake in Verizon Wireless, which will see tens of billions of pounds returned to UK investors.

:: A share placing is unlikely until later in the week at the earliest as Lloyds' managers focus on the successful spin-off of TSB into a standalone banking network on Monday.

:: Aides to Mr Osborne are determined to realise a return from part of the Lloyds stake before the Conservative Party holds its annual conference in Manchester next month. One said that recent improvements in the economic outlook allied to the imminent privatisation of Royal Mail and a sale of taxpayer-owned bank shares were part of "a narrative" that would bolster perceptions of the Chancellor's stewardship of the economy.

:: Senior Liberal Democrats are seeking assurances over Lloyds' future role in lending to small and medium-sized companies before they endorse any sale of Lloyds shares, according to Coalition sources.

The exact size of an initial Lloyds sale has not been determined, although analysts believe it is likely to account for roughly 10% of the bank's shares, or one-quarter of the Government's stake. That would be worth just over £5bn at today's share price just before the market close of 75.41p.

During the last 12 months, Lloyds shares have more than doubled as investors have begun to price in the bank's likely future profitability and potential shareholder returns.

In meetings with investors following last month's interim results, Antonio Horta-Osorio, Lloyds' chief executive, is understood to have pledged that the bank would seek to pay out up to 70% of its profits in dividends within three years.

Lloyds has been prohibited from paying dividends to ordinary shareholders since its £20bn bailout in 2008, which followed its takeover of the stricken mortgage lender HBOS.

Mr Horta-Osorio told Sky News this week that it was "the right thing" for the Chancellor to begin selling Lloyds shares.

The price of any Government placing of Lloyds shares would be crucial to Mr Osborne's presentation of a sale. The Labour government paid an average market price of 73.6p for the stake, and while an imminent placing may not take place above that level, it would be possible to do so for a price well in excess of the 61p at which the stake is recorded in the national accounts.

The lower figure does not take into account £2.5bn of fees paid by Lloyds for implicit guarantees covering its toxic loans in the wake of the 2008 rescue.

The Treasury, Lloyds and UKFI all declined to comment on Saturday.

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Flooding: Homes Evacuated And Cars Swept Away

Dozens of people were evacuated from their homes and cars and bridges swept away in torrential rain in north-east England.

Firefighters rescued residents and motorists in Saltburn, where two drivers watched their vehicles carried away by the flood water as the rain lashed the region on Friday.

Across the other side of the country a freak hail storm left parts of Cornwall covered in a blanket of white.

A Cleveland man is rescued by firefighters (Incidents on Teeside/Facebook)

Crews from the Royal National Lifeboat Institution (RNLI) in Redcar were alerted amid fears that the cars swept away still had their occupants inside.

Dave Cocks, from Redcar RNLI, said weather systems recorded 8mm of rainfall per hour.

It started mid-morning and "increased in ferocity" throughout the afternoon. Flooding in Redcar began about 3pm, and badly hit areas such as Loftus and Skinningrove, peaking about 7pm," he said.

"It was very intense in a very short time."

He went on: "There's an area at Saltburn very close to the sea where two streams converge and then flow out to the sea.

"They were both extremely swollen with flood water, and coincidentally there was quite a high tide.

"The initial report was that a bridge had collapsed and two cars swept into flood water, and two occupants had been carried out to sea.

Two cars are washed away in Saltburn (Incidents on Teeside/Facebook)

"We were preparing to launch when we got a call saying the police helicopter and fire services were on the scene and were able to confirm that everyone had been accounted for."

Cleveland fire fighters were joined by crews from North Yorkshire and Durham and Darlington as they carried out rescues at more than 10 different locations.

The fire service received 230 calls between 3.50pm and 10.40pm for assistance due to flooding, particularly in East Cleveland and Hartlepool.

A spokeswoman said: "Around 200 of the calls came within the three hour period between 6pm and 9pm.

"Appliances from across the brigade were committed to dealing with these incidents assisted by appliances from North Yorkshire and Durham and Darlington Fire and Rescue Services.

A lorry stuck under a bridge in Skelton (Incidents on Teeside/Facebook)

"We affected the rescue of at least 20 people in over 10 different locations where life was considered to be in danger or imminent danger from rising flood water.

"This included rescues from houses and vehicles, and in some cases involved the brigade rescue boat.

"During this extremely busy period the brigade also attended two road traffic collisions and a dwelling fire."

A Cleveland Police spokesman said properties in the Mersey Road area of Redcar were evacuated and all occupants had now returned home.

Several bungalows occupied by elderly residents were still inhabitable and temporary accommodation being sought for them.

He added: "There was a report from harbour police that there was a male on the roof of his car at the bottom of Tees Dock Road in Middlesbrough. He managed to get to safety."

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Exclusive: Hunt Warns On Winter A&E Care Crisis

By Thomas Moore, Health Correspondent

It will be 'very, very tough' for the NHS to avoid a repeat of last winter's A&E care crisis, Jeremy Hunt has warned for the first time.

In an exclusive interview with Sky News, the Health Secretary admits to being "concerned" about the high demand for emergency care and the pressure staff are under.

Asked how confident he is that patients will not experience a repeat of the long waiting times seen last year, Mr Hunt said: "It is going to be very, very tough.

"But we can get through this winter. It is entirely possible to meet A&E targets, and I am determined we should."

His warning comes as a poll commissioned for State Of Emergency, Sky News' weekend of live coverage from Nottingham's Queen's Medical Centre, shows that two thirds of people - 66% - believe A&E services are in crisis and patients are being put at risk.

Sky News is broadcasting from inside the Queen's Medical Centre, Nottingham

The Sky News poll of 1,106 people carried out by Survation also shows that more than eight in 10 (81%) of people believe the Government must take immediate action to avoid major issues in A&E.

And 65% blame government cuts for any staff shortages and poor levels of care. However, 75% of those questioned agreed that doctors and nurses were trying their best but were being worked too hard.

The poll also found that a large majority of people - 72% - believe that people visiting A&E for injuries sustained while drunk or under the influence of recreational drugs should have to pay extra towards the cost of treating them.

And more than 90% oppose the provision of breast enlargements and tattoo removals on the NHS.

To address the A&E care crisis, almost two thirds of people - 65% - think that consultants should be forced to work weekends and nights, with 43% saying that senior doctors who refuse should receive less pay.

Some 65% of those questioned also believe that NHS managers are paid too much.

Heath Secretary Jeremy Hunt

In the first three months of this year, 94 out of 148 hospital trusts failed to meet the target for treating 95% of patients within four hours of them arriving at A&E.

Although the pressure eased over the summer, waiting times have begun to climb once more. Some hospitals are already breaching the target, even before winter pressures kick in.

The government has given the NHS an extra £500m to pay for short-term measures over the next two years to help ease the pressure.

That could include employing more locum consultants in A&E departments and setting up GP surgeries inside hospitals.

"A lot of things are happening to give support to the front line," said Mr Hunt.

"But that's not to say we are not worried about it, because it is going to be very tough, and we understand that."

The National Director for Acute Episodes of Care for NHS England, Professor Keith Willett, told Sky News that demand for emergency care is likely to rise once again this winter.

He will shortly unveil plans to divert more A&E patients towards the care of GPs, paramedics and chemists.

But in the short term, patients will have to accept they have to wait for care.

"Safety is the priority," he said. "We will do everything we can to maximise the way patients receive their care as quickly and optimally as possible.

"But it is a pressured system and we have to work within the envelope we have and the skills and staff we have."

*As part of the poll 1,106 adults were surveyed on September 2-3 by Survation on behalf of Sky News.

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Abbott Wins: Australia 'Under New Management'

Tony Abbott has declared victory in Australia's general election after defeating prime minister Kevin Rudd.

Mr Abbott, the British-born leader of the Liberal Party-led coalition opposition has ended six years of Labor rule.

In his victory speech Mr Abbott said: "I can inform you that the government of Australia has changed. For just the seventh time in 60 years the government of Australia has changed.

"I declare that Australia is under new management and is once again open for business.

Abbott and Rudd on election posters in Sydney

"I now look forward to forming a government that is competent, that is trustworthy, and which purposely and steadfastly and methodically set about delivering on our commitments."

Earlier, in Brisbane, Mr Rudd conceded defeat. "A short time again I telephoned Tony Abbott to concede defeat at this national election," he said. "As prime minister of Australia, I wish him well in the high office of prime minister of this country."

With 80% of the votes counted, the Australian Electoral Commission showed Mr Abbott's party was leading in 88 seats in the House of Representatives, to Labor's 56.

Mr Rudd said Labor had "fought the good fight".

Voters cast their ballot in Sydney

He added: "Tonight is the time to unite as the great Australian nation.

"Because whatever our politics may be we are all first and foremost Australian and the things that unite us are more powerful than the things that divide us, which is why the world marvels at Australia."

He added: "I will not be recontesting the leadership of the parliamentary Labor Party. The Australian people I believe deserve a fresh start with our leadership." 

Defence minister Stephen Smith told the ABC broadcaster: "Pessimistically, I'm looking at a result which will be a 1996-type result, a heavy defeat for the government," he added, referring to the election which brought Liberal leader John Howard to power.

Mr Abbott casting his vote with his family beside him

Labor has been marred by relentless infighting - which saw Mr Rudd oust Australia's first female prime minister Julia Gillard in June - leaving the public frustrated and disillusioned.

Health Minister Tanya Plibersek said: "The clear take-out from this definitely is that disunity is death and we are not disciplined enough. I don't think the division or the pain was justified at any stage."

Former Labor prime minister Bob Hawke said personality politics had been allowed to overtake the party's message and policies.

"The personal manipulations and pursuits of interest have dominated more than they should and in the process the concentration on values has slipped.

"I really believe this was an election that was lost by the government rather than one that was won by the opposition."

Former Prime Minister Julia Gillard

Early poll numbers suggested big swings against the government in the key states of New South Wales and Queensland after more than 14.7 million electors took part in the mandatory ballot across the country.

During the five-week campaign, Mr Abbott gradually overtook once-popular Mr Rudd.

The growing number of asylum seekers has been a major theme in the election. Labor promised that every bona fide refugee who attempts to reach Australia by boat would be settled on Papua New Guinea or Nauru.

The Liberals promised new policies requiring the navy to turn asylum seeker boats back to Indonesia, where they launch, and the government to buy back ageing fishing boats from Indonesian villagers to prevent them falling into the hands of people smugglers.

Mr Abbott has also vowed to scrap a controversial carbon tax and instead introduce taxpayer-funded incentives for polluters to operate cleaner.

Mr Abbott was born in London and moved with his parents to Sydney at the age of two. Later, he returned to England to study at Oxford University as a Rhodes Scholar.

Mr Abbott has been in Parliament for almost two decades, and for a time was health minister.

He trained briefly as a priest, is a fitness fanatic famous for wearing tight swimming trunks and also volunteers for Australia's Rural Fire Service.

Deeply religious, some of his more conservative views on issues such as abortion and gay marriage have not pleased some.

Questions have also been asked about his attitude towards women with Ms Gillard famously labelling him a misogynist in a heart-felt speech in Parliament.

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John Kerry Makes Pitch For Syria Support

John Kerry has met EU ministers to try to bolster support for strikes on Syria after a G20 summit ended with no agreement on how to tackle the alleged use of chemical weapons.

The US Secretary of State held talks with 28 European foreign ministers in the Lithuanian capital Vilnius before travelling to Paris and London on Sunday to meet Arab leaders, including Palestinian President Mahmoud Abbas.

After the meeting, French foreign minister Laurent Fabius said there was agreement that all indications point to the Assad regime being responsible for a gas attack in Damascus that may have killed more than 1,400 people.

EU High Representative Catherine Ashton called for "a clear and strong response" to the attack but officials said the European Union has agreed that any potential strike against Syria should wait until after UN inspectors publish their report.

Respected German newspaper Frankfurter Allgemeine Sonntagszeitung has reported that the UN's chemical weapons experts could submit their initial findings by the end of next week.

Mr Kerry was boosted by Germany's decision after the meeting to back a strongly-worded statement issued at the end of the G20 summit in Russia, blaming the Syrian government.

After a morning in Vilnius, Mr Kerry spoke to Laurent Fabius in Paris

He said: "We are very grateful for the statement that came out of the meeting today with respect to Syria, a strong statement about the need for accountability."

Later, Mr Kerry held further talks with Mr Fabius in Paris and spoke in French and English as he outlined the case for military action.

He said the world should not be "spectators to slaughter", but said President Obama had not yet decided whether to wait for the UN inspection report before taking action.

Middle East peace negotiations and other issues are on the agenda for Mr Kerry's talks at all three stops, but the ongoing crisis in Syria will overshadow his visit. 

Meanwhile, President Barack Obama has arrived back in Washington after huge divisions emerged over the Syrian crisis at the G20 summit in St Petersburg, Russia.

Mr Obama and Mr Putin are divided over military intervention

In his weekly address to the American people, Mr Obama sought to emphasize that military action in Syria would not turn into a long-term conflict like Iraq or Afghanistan.

He said: "There would be no American boots on the ground.  Any action we take would be limited, both in time and scope – designed to deter the Syrian government from gassing its own people again and degrade its ability to do so.

"We cannot turn a blind eye to images like the ones we've seen out of Syria. Failing to respond to this outrageous attack would increase the risk that chemical weapons could be used again, that they would fall into the hands of terrorists who might use them against us, and it would send a horrible signal to other nations that there would be no consequences for their use of these weapons." 

A statement signed by 11 of the G20 nations said they hold Syrian President Bashar al Assad responsible for the alleged chemical attack.

Only 11 G20 nations issued the communique urging a tough line

The joint statement issued by Australia, Canada, France, Italy, Japan, South Korea, Saudi Arabia, Spain, Turkey, the UK and the US condemned the "horrific" attack in Damascus and called for a "strong international response", but it did not specify military action.

During the summit Mr Obama said the world could not "stand idly by", but Russian President Vladimir Putin warned it would be "outside the law" to attack without the UN's blessing.

Mr Putin also said Russia would "help Syria" if the US were to strike, pointing to existing military, economic and humanitarian co-operation.

Washington has prepared the ground for possible airstrikes, evacuating non-essential embassy staff from Beirut and urging Americans to avoid all travel to Lebanon and southern Turkey.

As well as the stubborn international differences, the US administration still has to win backing from Congress for any action against Syria.

Congress reconvenes on Monday and Mr Obama is to address the nation on Tuesday. But he acknowledged that convincing Congress to back military action against the Syrian regime would be a "heavy lift".

"I understand the scepticism," Mr Obama said.

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Buckingham Palace Break-In: Two Arrested

Security Scares For Royal Family

Updated: 6:27am UK, Saturday 07 September 2013

The break-in at Buckingham Palace is the latest in a series of security scares involving the Royal Family.

:: In March 2011, a car carrying the Prince of Wales and the Duchess of Cornwall was mobbed by demonstrators who had split from a protest against higher university tuition fees.

Camilla was visibly distressed after being poked in the ribs with a stick through an open window in the distinctive Rolls-Royce Phantom VI as she and Charles travelled to the Royal Variety Performance at the London Palladium.

:: In 2003, comedian Aaron Barschak managed to get into Prince William's 21st birthday party at Windsor Castle.

The self-styled "comedy-terrorist" set off a series of alarms and was caught on CCTV before he joined 300 guests at the bash and was removed.

:: In 1994, student David Kang charged at Charles while firing a starting pistol during a ceremony in Sydney, Australia.

Kang was wrestled to the ground by New South Wales premier John Fahey and another man, while Charles was praised for his calm reaction.

:: In 1981, six blank shots were fired from the crowd while the Queen rode during the Trooping the Colour ceremony.

The Queen's horse was startled but she managed bring it back under control while police rushed to grab the shooter.

:: In 1974, Princess Anne was the target of an apparent kidnap attempt in The Mall near Buckingham Palace.

Four people, including her bodyguard, Jim Beaton, were injured after shots were fired when their car was forced to halt by another vehicle which blocked their route.

A police officer chased the driver, Ian Ball, and brought him to the ground before arresting him.

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Michael Le Vell: Man Held Over Facebook Post

A man has been arrested over a Facebook post relating to the alleged victim in the trial of Coronation Street's Michael Le Vell.

More follows...

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